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General NPI Number Information
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NPI Number | 1114721743
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Entity Type | Individual
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Provider Name | BRANDON LAWRENCE ASW
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 260 CALIFORNIA DR
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City | YOUNTVILLE
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State | CA
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Zip | 94599-1412
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Country | US
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Telephone | 707-944-4932
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Fax |
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Provider Business Mailing Address
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Address Line | 130 BANTRY DR
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City | VACAVILLE
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State | CA
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Zip | 95688-8503
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Country | US
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Telephone | 720-563-9631
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW128192
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License Number State | CA
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